产前超声筛查中孕期胎儿心脏畸形对诊断染色体异常价值的Meta分析

Value on prenatal ultrasound screening of fetal cardiac malformations in diagnosis of chromosomal abnormalities during second trimester:Meta-analysis

目的采用Meta分析探讨中孕期胎儿超声心动图检查发现孤立性室间隔缺损、除外孤立性室间缺损的其他心脏及大血管畸形对染色体异常的产前筛查价值。方法检索Cochrane Library、PubMed、EMBASE、SCI、万方、维普、中国知网数据库中的中英文文献,按照纳入和排除标准筛选文献并进行偏倚风险评价,提取相关资料,检验异质性并选择相应的效应模型合并效应量,采用Meta-Disc 1.4软件,计算汇总敏感度、特异度及95%CI,绘制汇总受试者工作特征曲线,计算曲线下面积,对异质性文献进行敏感度分析。结果共纳入12篇文献,6篇文献分析了孤立性室间隔缺损对染色体异常的产前筛查价值,8篇文献分析了其他心脏及大血管畸形对染色体异常的产前筛查价值。采用随机效应模型合并效应量,两组汇总敏感度、特异度分别为32%、99%及29%、99%,SROC AUC分别为0.833 7及0.884 6,两组的汇总敏感度差异无统计学意义(P>0.05)。结论中孕期超声心动图显示胎儿心脏畸形对染色体异常有一定的产前筛查价值,胎儿孤立性室间隔缺损是染色体异常的危险因素,存在其他心脏及大血管畸形未使染色体异常的风险增加。

Objective To explore value on prenatal ultrasound screening of isolated ventricular septal defects, other cardiac vascular abnormalities for chromosomal abnormalities during second trimester in diagnosis of chromosomal abnormalities using Meta-analysis. Methods Cochrane Library, PubMed, EMBASE, SCI, VIP, CNKI were searched, including literatures were chozen and risk of bias were assessed, relevant information was extracted, the effect model on the heterogeneity test results was selected. Pooled sensitivity, specificity and 95%CI were computed with Meta-Disc 1.4 software, summary receiver operating characteristic curve （SROC） were drew and the area under the curve （AUC） was calculated. Finally, sensitivity analysis was performed. Results Twelve articles were included, six on isolated ventricular septal defect and eight on other heart vascular abnormalities for prenatal screening for chromosomal abnormalities. Summary sensitivity, specificity of ventricular septal defect and other heart vascular abnormalities was respectively 32%, 99% and 29%, 99%, SROC AUC was 0.833 7 and 0.884 6. Summary sensitivity difference between the two groups was not statistically significant （P〉0.05）. Conclusion The second trimester fetal echocardiography examination shows fetal heart defects have some prenatal screening value for chromosomal abnormalities, fetal isolated ventricular septal defect is a risk factor for chromosomal abnormalities, the presence of other cardiac vascular abnormalities do not make an increasing risk of chromosomal abnormalities.